This invention relates to .Iadd.a device for the medical placement of a tube, for example, .Iaddend.the medical treatment of patients who have an obstructed airway by means of tracheostomy or cricothyrotomy. Under emergency circumstances, all physicians and other medical personnel, no matter what their specialty, are expected to know how to protect and maintain a patient's airway. Even under non-emergency circumstances, an anesthesiologist, for example, must maintain the airway, ventilation and oxygenation of a patient who has been rendered unconscious by the doctor or another health care professional by use of sedatives, hypnotics, or other agents. These responsibilities have extended even to such health care professionals as dentists, podiatrists, and emergency medical technicians- persons who may witness an allergic reaction in a patient brought on by use of drugs or remedies which have been administered.
The typical methods of maintaining a patient's airway are by anatomical positioning, clearing the passageway of foreign materials, positive pressure mask ventilation, oral/nasal airways, or oral/nasal approach to tracheal intubation. Following failure of all of the typical methods of ventilation, the last method of resort is transtracheal intubation via formal tracheostomy or cricothyrotomy. These procedures, though infrequently required, are recommended for use as a last means method. See, Clinics of Anesthesiology, Tunstall and Sheikh, 1986.
In many patients, establishment of the airway may be formidable due to morphological anomalies, such as a large tongue, excessive soft tissue or tracheal displacement. Inabilities of the patient to extend the head and neck or to open the mouth wide enough contribute to the difficulty of maintaining the airway, as do other morphological anomalies or physiological events such as floppy epiglottis or laryngospasm.
Even the use of formal tracheostomy presents inherent problems. Tracheostomy requires instrumentation which may not be available in emergency situations. Additionally, given the time constraints involved in an emergency, a tracheostomy may yield to the more expedient procedure of cricothyrotomy. Circothyrotomy, considered by many to be the preferred method of establishing an airway after other methods have failed, is achieved by transtracheal intubation via a percutaneous puncture through the cricothyroid membrane into the trachea.
Methods for performing transtracheal intubation have been disclosed in the prior art. U.S. Pat. No. 4,677,978 to Melker describes a method for establishing a transtracheal airway. However, by its design, the method is inherently ineffective in that once the percutaneous placement of the needle is made, the needle and syringe are removed so that a guide wire can be placed through the catheter; this feature of the method significantly increases the risk that the tube has not been properly placed in the trachea, and subsequent placement of the wire through the catheter may result in the wire being threaded into the subcutaneous tissues, or be unable to be threaded at all. The system is also of a design which requires the user to look away momentarily to grasp other pieces of the instrument, movement which greatly impedes the quick and accurate placement of the device.
Other devices exist on the market which have drawbacks similar to those described above. In particular, these devices are complex, difficult to use and manipulate and often requiring instructions. It requires the practitioner to look away during placement of the device which greatly increases the chance of improper establishment of the airway. Even devices on the market which are composed of a simple curved metal needle with attached blade and syringe present problems in placement. In use, the hollow needle of the device may be properly placed, but the tip of the blade may be improperly positioned in the back wall of the trachea. Also, if the patient moves, coughs, or begins to choke in a gagging response, the blade may act as a scalpel causing severe damage.
The invention herein presents a new and more easily utilized apparatus for achieving cricothyrotomy which overcomes many of the problems encountered with the other methods enumerated above. Ideally, a transtracheal device should be designed for rapid and easy placement, with a high rate of success in establishing and maintaining the patient's airway, while being safe to use, easily utilized by all practitioners regardless of level of expertise, and should be concentrically and concisely designed. The invention herein fulfills these objectives, and therefore presents a new and useful device in relation to the prior art. .Iadd.The device according to the present invention can also be utilized for insertion of a tube for such as intravenous use, intraplural use, intraabdominal use or urological use. The following summary of the invention, drawings and detailed description of the preferred embodiments will be described in conjunction with transtracheal use; however, the scope of the invention should be determined solely by the language and limitations of the claims. .Iaddend.